What paves the road to maternal health care use? Investigating education, urban-rural residence, social-networks and supernatural beliefs in the Far-North province of Cameroon
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Every day, 1500 women die in pregnancy or due to childbirth related complications worldwide. Sub-Saharan Africa has the highest rates of maternal mortality. Maternal health care use is critical in reducing maternal mortality worldwide. Cameroon has one of the highest maternal mortality rates worldwide (over 1000 deaths per 100,000 live births), but there is little knowledge about maternal health care use in the Far-North province. The purpose of this study was to examine the role of education, urban and rural residence, social networks, and cultural beliefs on the use of maternal health care use in the Far-North province. A maternal health questionnaire was completed by 110 Cameroonian women between the ages of 18-45. Participants were recruited door-to-door in the urban town of Maroua and rural village of Moutourwa in the Far-North province. Questionnaires assessed maternal health care history, social networks and demographics. Follow-up interviews were conducted with nine questionnaire participants to gain a greater understanding of how daily activities, food consumption and beliefs in the supernatural impact maternal health care use. Poisson regression analyses were used to determine the association among education, social network characteristics, urban and rural residence, and maternal health care service use in Maroua and Moutourwa. Thematic analysis of semi-structured interviews revealed themes of witchcraft, diet and social ties. Women in the rural sample had a greater risk of failing to seek prenatal consultations than women in the urban sample (RR: 0.73; 95% CI: 0.61-0.88). When stratified by urban/rural location, education played a greater role in women’s use of prenatal services in Moutourwa (RR: 0.69; 95% CI: 0.50-0.94) compared to Maroua (RR: 0.66; 95% CI: 0.41-1.06). Qualitative analyses suggested that beliefs in witchcraft may deter women from speaking about pregnancy, and that mothers often believe that envious women can cause harm to mother and child through the use of witchcraft. Social network analysis revealed that women who belonged to a women’s organization were more like to use prenatal services (RR: 1.31; 95% CI: 1.07-1.62). Both qualitative and quantitative findings have implications for maternal health interventions in the Far-North province of Cameroon.